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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Incidental Atrial Amyloid on Surgical Pathology Revealing Transthyretin Cardiac Amyloidosis

  • Jonathan Wright1
  • Fadi Haroun1
  • Adam Potter2,3
  • Ajay Vallakati3
  • Bryan Whitson4
  • Rami Kahwash3
4 affiliations
  1. 1Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
  2. 2Cardio-Oncology Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  3. 3Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
  4. 4Division of Cardiac Surgery, The Ohio State University, Columbus, Ohio, USA
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Abstract

Background: Atrial amyloid is frequently encountered incidentally on surgical specimens and often attributed to isolated atrial amyloidosis. However, atrial amyloid may also represent early transthyretin amyloid (ATTR) cardiac amyloidosis (CA), a treatable condition.

Case Summary: A 70-year-old man presented with worsening dyspnea, lower-extremity edema, and atrial fibrillation. He underwent coronary artery bypass grafting with MAZE procedure and left atrial appendage ligation. Pathology of the atrial appendage revealed Congo red-positive amyloid deposits. Mass spectrometry confirmed transthyretin-type amyloid. Transthyretin gene sequencing was negative, and technetium-99m pyrophosphate scintigraphy demonstrated significant cardiac uptake, confirming wild-type ATTR CA. He was treated with tafamidis and spironolactone, maintained sinus rhythm after cardioversion, and remained clinically stable at 1-year follow-up.

Discussion: This case highlights the diagnostic value of atrial tissue histopathology in detecting occult ATTR amyloidosis. Further, it emphasizes the importance of comprehensive evaluation and early initiation of disease-modifying therapy. Proper evaluation of atrial amyloid can alter management and improve patient outcomes.

Take-Home Messages: Atrial amyloid identified on surgical pathology should prompt comprehensive evaluation for CA. Atrial amyloid should not be assumed to represent isolated atrial amyloidosis, as it may provide an opportunity for early diagnosis and initiation of disease-modifying therapy.

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Cite

BibTeXRIS
BibTeX
@article{wright2026incidental,
  title = {{Incidental Atrial Amyloid on Surgical Pathology Revealing Transthyretin Cardiac Amyloidosis}},
  author = {Jonathan Wright and Fadi Haroun and Adam Potter and Ajay Vallakati and Bryan Whitson and Rami Kahwash},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.109925},
  url = {https://doi.org/10.1016/j.jaccas.2026.109925},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Incidental Atrial Amyloid on Surgical Pathology Revealing Transthyretin Cardiac Amyloidosis
AU  - Jonathan Wright
AU  - Fadi Haroun
AU  - Adam Potter
AU  - Ajay Vallakati
AU  - Bryan Whitson
AU  - Rami Kahwash
PY  - 2026
DA  - 2026/08/25
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109925
UR  - https://doi.org/10.1016/j.jaccas.2026.109925
AB  - Background: Atrial amyloid is frequently encountered incidentally on surgical specimens and often attributed to isolated atrial amyloidosis. However, atrial amyloid may also represent early transthyretin amyloid (ATTR) cardiac amyloidosis (CA), a treatable condition.  Case Summary: A 70-year-old man presented with worsening dyspnea, lower-extremity edema, and atrial fibrillation. He underwent coronary artery bypass grafting with MAZE procedure and left atrial appendage ligation. Pathology of the atrial appendage revealed Congo red-positive amyloid deposits. Mass spectrometry confirmed transthyretin-type amyloid. Transthyretin gene sequencing was negative, and technetium-99m pyrophosphate scintigraphy demonstrated significant cardiac uptake, confirming wild-type ATTR CA. He was treated with tafamidis and spironolactone, maintained sinus rhythm after cardioversion, and remained clinically stable at 1-year follow-up.  Discussion: This case highlights the diagnostic value of atrial tissue histopathology in detecting occult ATTR amyloidosis. Further, it emphasizes the importance of comprehensive evaluation and early initiation of disease-modifying therapy. Proper evaluation of atrial amyloid can alter management and improve patient outcomes.  Take-Home Messages: Atrial amyloid identified on surgical pathology should prompt comprehensive evaluation for CA. Atrial amyloid should not be assumed to represent isolated atrial amyloidosis, as it may provide an opportunity for early diagnosis and initiation of disease-modifying therapy.
SN  - 2666-0849
ER  -